tailieunhanh - Case lâm sàng sản khoa - Case 5

Tham khảo tài liệu 'case lâm sàng sản khoa - case 5', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 23 A 31 -year-old G3 P2 woman at 39 weeks gestation arrives at the labor and delivery area complaining of strong uterine contractions of 4-hr duration her membranes ruptured 2 ago. She has a history of herpes simplex virus infections. She denies any blisters and her last herpetic outbreak was 4 months ago. She notes a 1-day history of tingling in the perineal area. On examination her BP is 110 60 temperature is 99 F and HR is 80 bpm. Her lungs are clear to auscultation. Her abdomen reveals a fundal height of 40 cm. The fetal heart rate is 140 bpm reactive and without decelerations. The external genitalia are normal without evidence of lesions. The vagina cervix and perianal region are normal in appearance. The vaginal fluid is consistent with rupture of membranes. What is your next step What is the most likely diagnosis 96 CASE tills OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 23 Herpes Simplex Virus Infection in Labor Siiniiiiaiy A 31-year-old G3 P2 woman at 39 weeks gestation is in labor and her membranes ruptured 2 hours ago. She has a history of herpes simplex virus 1 ISV infections. She has a 1-day history of tingling in the perineal area. Next step Counsel patient about risks of neonatal 1ISV infection and offer a cesarean delivery. Most likely diagnosis Herpes simplex virus recurrence with prodromal symptoms. Analysis Objectives 1. Understand the indications for cesarean delivery due to herpes simplex virus. 2. Know that herpes simplex virus may cause neonatal encephalitis. 3. Understand that symptoms of prodromal infection may indicate viral shedding. Considerations rhe patient is in labor and has experienced rupture of membranes. She has a history of herpes simplex virus infections. Although she has no lesions visible and is taking acyclovir suppressive therapy she complains of tingling of the perineal region. These symptoms are sufficient to suggest an I ISV outbreak. With herpes simplex virus shedding of the genital tract there is risk of neonatal .